How does an acute compartment syndrome develop without trauma?

Background. The occurrence of an acute compartment syndrome of the upper leg, purportedly without any causative trauma, was the basis for an analysis of the pathogenesis of compartment syndrome. Material and methods. The case of this disease in a top athlete is presented. As a result of a literature search it became clear that both the compartment syndrome and rhabdomyolysis have an almost identical pathophysiological process. Result. Unphysiological tissue pressures in the area of an affected musculature can trigger local blood circulation disorders due to disruption of the energy supply. In an unfavorable constellation this results in disintegration of muscle cells at the cellular level. A cascade-like release of cell contents is the inevitable result. The contents of the lysed muscle cells cause a further massive increase in local tissue pressure, which closes and maintains a vicious circle which is difficult to break. Conclusion. Decisive knowledge of the pathophysiological processes leading to a vicious circle should facilitate the treatment of affected patients. In the case of muscle injury the possibility of development of a compartment syndrome and/or rhabdomyolysis should be considered. When the routine treatment procedures for muscle injuries have relevant effects on the development of a compartment syndrome, the question should be raised whether these forms of treatment are sensible or even possibly dangerous. In such cases the therapist should be able to immediately initiate an operative or intensive medical treatment in order to avoid disastrous clinical consequences